Sexual And Reproductive Health

1. A 23 year old woman has been assessed at the family planning clinic and is eligible for the combined oral contraceptive pill. Her LMP was 7 days ago with a regular 28 day cycle. She is has not had unprotected intercourse. When can she start taking the pill?

A. Immediately
B. Day 1 of her cycle
C. Immediately plus barrier contraception for 7 days
D. Day 1 to 7 of her cycle
E. Day 2 to 7 of her cycle

2. Pt treated with rectal administration of drugs for treatment of IBD. Such treatment reduces efficacy of which contraceptive methods.

A. COC
B. Progestogen – only pill
C. Latex condoms
D. Non-latex diaphragm

3. Which of the following statements regarding use of DMPA by women with obesity is true?

A. Benefits of use of DMPA generally outweigh risks for women with multiple risk factors for CVD
B. Teenagers who are overweight may be at increased risk of weight gain with DMPA use compared with teenagers who are not overweight.
C. The negative effect of DMPA on bone mineral density (BMD) is countered by the protective effect of higher BMI on BMD.
D. Evidence suggests that effectiveness of DMPA may be reduced by increased BMI.
E. None of the above

4. A 27-year-old woman who has been using the progestogen-only injectable presents complaining of frequent bleeding since her second injection 6 weeks ago. She experiences migraine with aura. After consideration and exclusion of other factors, what is the single most appropriate treatment to offer her?

A. A COC used cyclically or continuously for 3 months
B. Another injection of depot medroxyprogesterone acetate
C. Mefenamic acid
D. The desogestrel (DSG) progestogen-only pill (POP) once daily
E. Implanon

5. A 45-year-old woman who has been using the POP for the past 10 years with regular bleeds presents complaining that these are becoming erratic and more frequent. She has had no change in partner and has not missed any pills. What is the single most appropriate management of this woman?

A. Advise she is likely menopausal and that contraception can be stopped
B. Advise she should take two POP a day to regulate her bleeding
C. Advice will settle in few months
D. Examine the patient and exclude pregnancy and pathology before changing her contraception
E. Switch her onto a combined hormonal contraceptive to regulate her bleeding

6. A 26-year-old para 1 comes to your clinic requesting contraception. She mentions that her maternal aunt had deep vein thrombosis (DVT) and is on warfarin. She is worried that if she takes hormonal contraception she will also develop DVT. Which of the following advice regardling DVT is incorrect.

A. Observational studies have reported that the transdermal patch has a somewhat similar level of VTE risk to combined oral contraceptives containing second-generation progestogens
B. Combined oral contraceptives containing a third generation progestogen is associated with an increased risk of venous thromboemolism (VTE) when compared with those containing second generation progestogens
C. The risk of VTE increases with the number of years of usage of a combined hormonal pill
D. There is little or no data to suggest that there is an increased risk of VTE with oral or injectable progesterone only contraceptives methods
E. Thrombophillia screen is not recommended routinely before use of combined hormonal contraceptive

7. Which of the following is true? UPA-EC may be less effective if a woman:

A. Has severe asthma managed with oral glucocorticoids.
B. Is taking truvada and raltegravir given for post-exposure HIV prophylaxis after sexual exposure (PEPSE).
C. Commences a hormonal contraceptive on the same day.
D. Takes UPA-EC between 0 and 72 hours after UPSI.
E. Given to BMI > 26

8. A woman presents for a Cu-IUD for EC after using her combined hormonal contraception incorrectly only during Week 1. A Cu-IUD can be inserted for EC up to how many days after the start of the hormone-free interval?

A. 5 days
B. 10 days
C. 13 days
D. 15 days
E. 18 days

9. The Standard Days Method® of contraception involves abstaining or using additional precautions:

A. From Day 5 until Day 19 of a 28–32 day menstrual cycle
B. From Day 8 until Day 19 of a 26–32 day menstrual cycle
C. From Day 1 until Day 19 of a 28–32 day menstrual cycle
D. From Day 7 until Day 19 of a 26–32 day menstrual cycle
E. From Day 6 until Day 22 of a 26–32 day menstrual cycle

10. A woman presents enquiring about the use of breastfeeding as a contraceptive. Which of the following best describes the criteria that she would need to fulfil?

A. Amenorrhoeic, fully or nearly fully breastfeeding
B. Amenorrhoeic, fully or nearly breastfeeding, less than 9 months postpartum
C. Amenorrhoeic, fully or nearly fully breastfeeding less than 6 months postpartum
D. Amenorrhoeic, less than 6 months postpartum, breastfeeding every 6-8 hours
E. None of the above.

11. Which of the following UK Medical Eligibility for Contraceptive Use (UKMEC) recommendations for a woman with a diagnosis of IBD is correct?

A. POP: UKMEC 4
B. Depot medroxyprogesterone acetate: UKMEC 1
C. Levonorgestrel-releasing intrauterine system (LNG-IUS): UKMEC 2
D. Combined oral contraception (COC): UKMEC 3
E. LNG-IUS: UKMEC 3

12. Which of the following statements regarding Emergency Contraception is false?

A. The primary mechanism of contraceptive action of the copper intrauterine device (Cu-IUD) is inhibition of fertilisation by its toxic effect on sperm and ova.
B. Given that the earliest implantation is believed to occur 6 days after ovulation, a Cu-IUD can be inserted up to 6 days after the first UPSI in a cycle.
C. If fertilisation does occur, the local endometrial inflammatory reaction resulting from the presence of the Cu-IUD prevents implantation.
D. The mechanism of contraceptive action of oral EC is to delay or inhibit ovulation for at least 5 days
E. All the above statements are true.

13. The woman is currently using the LNG-IUS for contraception which is due to be replaced and they are considering sterilisation as an alternative option. She has a body mass index of 40 kg/m2 and a history of heavy menstrual bleeding, which was improved after LNG-IUS use. Both partners are willing to be sterilised. What is the single most appropriate advice to offer this couple?

A. Either partner could be sterilised but female sterilisation would be best as most women become amenorrhoeic.
B. Vasectomy is advised as female stz can result increses in HMB.
C. Either partner could be sterilised but female sterilisation increases bleeding, therefore vasectomy is the best option.
D. Either partner could be sterilised but the LNG-IUS is also highly effective and would help with heavy menstrual bleeding.
E. Due to her body mass index, she is not a candidate for sterilisation; therefore vasectomy is the best option.

14. A 42-year-old woman presents to the labour ward at 34 weeks’ gestation in pre- term labour. She progress very quickly and proceeds to have an emergency Caesarean section for fetal distress. She was discharged home after 1 week as her baby was admitted to the special care baby unit. Two weeks later, she attends the GP centre seeking contraception. She wants to continue to breastfeed her baby.

A. Levonorgestrel-releasing intrauterine system (Mirena coil)
B. Noriday 450 mcg
C. Combined oral pill
D. Sterilisation
E. Cerazette – 75 mcg

15. A 20-year-old, BMI 30 presents to the emergency gynaecology services at a hospital at midnight for advice. She gives a history of condom rupture while having sexual intercourse 3 hours ago. She is worried that she will get pregnant and her parents will abandon her. She has erratic cycles and prefers to continue pregnancy is by chance it occurs.

A. LNG- 3mg
B. Cu-T
C. UPA 30 mg
D. LNG- 15 mg
E. Quick start contraception

Sexual And Reproductive Health

Sexual And Reproductive Health

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